Social Accountability and the Physician Workforce

Aligning Physician Training with Societal Healthcare Needs

The social accountability of medical education concerns how physicians trained by educational institutions respond to local communities’ healthcare needs. This encompasses the number of physicians, their distribution across practice locations and specialties, their clinical competence, and whether residents have continuous access to care. These outcomes depend on faculty availability, clinical clerkship capacity, post-graduation training opportunities, and working conditions.

Linking Public Training Finance with Graduate Outcomes

This policy discussion of public funding for US graduate medical education (GME) reviews existing reports, financial data, and examples of outcome measurement and proposes strategies for implementing accountability (Phillips et al., 2022). As of 2020, federal and state governments supported 139,848 training positions at 1,657 teaching hospitals with approximately $19 billion annually. The authors describe continued public support and the training of physicians who meet societal healthcare needs as mutual obligations that constitute an implicit social contract. Medicare provided $11.218 billion in support in 2019, but the Centers for Medicare & Medicaid Services (CMS) lacked the authority to set educational quality or workforce goals independently of financial oversight. The Department of Veterans Affairs provided $1.6 billion in 2020, and the Veterans Health Administration (VHA) supported over 11,000 training positions. This funding lacked a mechanism for overseeing educational outcomes. The Health Resources & Services Administration (HRSA) supported teaching health center and children’s hospital GME with approximately $500 million in 2019. It was required to evaluate and report on training costs and workforce outcomes. State government support exceeded $5 billion as of 2018, with the scope of accountability varying by funding entity.

The authors distinguish between outcome assurance and outcome improvement. Outcome assurance addresses the results funders expect, such as workforce distribution by region and specialty, diversity, physician competence, and healthcare costs. Outcome improvement involves adjusting education through standardized evaluation and feedback on graduates’ clinical outcomes. The 1995 World Health Organization social accountability grid identifies priorities for institutional improvement by mapping relevance, quality, cost-effectiveness, and equity across education, research, and service. The NYU Grossman School of Medicine compared its graduates’ value-based care and total healthcare costs with those of graduates from other training institutions. It shared the data with educators and administrators. The University of Minnesota’s Medical Education Outcomes Center integrated 24 data sources to link educational and clinical data. The American Board of Family Medicine assessed practice readiness, burnout, practice type, and location through surveys at the end of training and three years later. The cross-sectional census of physicians three years after training provided programs with feedback.

Medicare claims data and hospital cost reports can serve as a starting point. In 2018, training FTEs above the Medicare funding cap numbered 22,150, and reported direct education FTEs above the cap represented over $2.5 billion. Interpreting these outcomes requires examining the mix of other funding sources and the proportion of fellowship positions. It also requires accounting for physicians’ training across multiple institutions and practice in different healthcare systems. The authors categorize the purposes of data collection as quality assurance, quality improvement, and research. They propose establishing inter-institutional data agreements and infrastructure for ethical data integration. A GME consortium organized by the federal government or medical education organizations would support these efforts. The proposal also links CMS’s evaluation authority, VHA’s tracking of graduate practice, HRSA’s evaluation capacity, and accrediting bodies’ quality improvement requirements. The WWAMI program, with its sustained rural training and outcome evaluation, illustrates how funding can be linked to social goals.

Education, Training, and Working Conditions to Support Medical School Expansion

This editorial on UK medical school expansion synthesizes existing statistics and surveys, policy documents, and international cases to review healthcare infrastructure, clinical education capacity, and workforce retention (Ferreira & Collins, 2025). The editorial reported over 10,000 secondary care physician vacancies in England. The NHS Long Term Workforce Plan included a goal to double medical school admission quotas to 15,000 annually by 2031. The subsequent 10 Year Health Plan for England outlined an approach to strengthening universities that had broadened access to education rather than specifying quota targets. The authors review these expansion plans alongside the capacity of beds, operating theaters, and clinical facilities. The number of beds per 1,000 population in the UK decreased from 3.1 in 2000 to 2.4 in 2021, while Germany maintained a level of over 8. Bed numbers are a proxy that captures outpatient care and other services only to a limited extent.

Medical Schools Council data showed that 35% of clinical academic and research staff were over 55. The authors identify educator succession and workload as considerations in accommodating more students. Foundation Programme and specialty training positions were also limited. In a national survey of UK medical students, 23.1% of respondents were confident that they could secure a specialty training position after completing the Foundation Programme. In 2023, over 11,000 doctors relinquished their UK medical licenses. More than one-third of medical students indicated an intention to leave the NHS within two years of graduation by moving overseas or leaving the profession. The authors use the “leaky bucket” metaphor to argue for policies that address training opportunities, job satisfaction, and workforce retention alongside the training of new physicians.

The medical doctor degree apprenticeship was suspended indefinitely after a pilot. International recognition of qualifications and career opportunities for socioeconomically disadvantaged students were identified as key issues. Four-year undergraduate medical education was examined in terms of how its clinical exposure, assistantships, electives, and research experiences compare with those of existing five- or six-year programs. The General Medical Council’s self-assessments, assessment visits, annual checks, and final approvals require personnel and resources. New universities’ reliance on international student tuition fees and the long-term retention of graduates were also discussed in relation to sustaining the NHS workforce. International cases included education and employment conditions following the expansion of private medical schools in India, and the policy to expand annual admission quotas by 60% alongside collective action by residents in Korea. The authors recommend pausing expansion until clinical education capacity, educational standards, and sustainable career pathways are assured.

Composition of Basic Science Faculty and Training of Future Personnel

This cross-sectional study of basic science faculty in Korea uses national survey reports and administrative survey data from the Korean Association of Medical Colleges (KAMC) (Park et al., 2025). From March to June 2023, the research team collected data from 40 domestic medical schools on faculty numbers by rank, new hires over the past three years, faculty scheduled to retire within the next five years, and graduate student numbers. The research team conducted frequency analyses and calculated descriptive statistics using IBM SPSS 27, comparing faculty by MD and non-MD status, rank, region, and school establishment type. Traditional basic science included anatomy, physiology, biochemistry, pharmacology, microbiology, parasitology, pathology, and preventive medicine. Emerging fields formed a separate category, as did medical education and medical humanities and social sciences. Of the 1,638 faculty, 1,316 (80.4%) were in traditional basic science, 223 (13.6%) in emerging fields, and 99 (6.0%) in medical education and medical humanities and social sciences. MDs numbered 880 (53.7%) and non-MDs numbered 758 (46.3%).

Traditional basic science included 770 MD faculty: 562 full professors, including those scheduled to retire, 91 associate professors, and 117 assistant professors. Pathology and preventive medicine accounted for large shares of MD faculty, with 245 and 157, respectively. Of the 179 new hires in traditional basic science from 2020 to 2022, 96 were MDs and 83 were non-MDs. Excluding pathology and preventive medicine, new MD hires numbered 39. Based on average numbers per school, MDs outnumbered non-MDs among full professors across all regions and establishment types. Among associate professors, MDs were fewer than non-MDs except in national medical schools in the capital region. Non-MDs also outnumbered MDs among assistant professors in non-capital regions. The proportion of full professors increased from 58.2% in 2013 to 68.0% in 2022. Applying a ratio of 24.4 students per professor, the authors estimate that an increase of 1,000 students requires an additional 41 anatomy professors, while an increase of 2,000 students requires approximately 82.

The comparison of anticipated retirements and numbers in training used 2022 as its reference year. MD faculty scheduled to retire within five years numbered 132, while MDs enrolled in basic science graduate schools numbered 104, a difference of 28. Non-MD graduate students numbered 1,124, while non-MD faculty scheduled to retire numbered 97. The number of MD graduate students exceeded that of MD faculty scheduled to retire only in pharmacology and emerging fields. Because this difference assumes that all current graduate students are hired as faculty, its interpretation depends on the timing of graduation and hiring, as well as graduates’ actual career choices. Comparisons also depend on differences across schools in departmental structures, faculty titles, criteria for full-time faculty, and field classifications, including the inclusion of pathology and preventive medicine. The authors describe MD faculty’s role in supporting integrated basic and clinical education and clerkships. They propose supporting basic science careers through medical student participation in research, standardized training, financial support, and career recognition.

A Medical School Case Linking Regional Origin Selection and Admission Preparation

This case report examines Southern Illinois University School of Medicine (SIU SOM), established in 1970 to secure a medical workforce for central and southern Illinois (Han & Klamen, 2024). In Illinois, 75% of residents are concentrated in the Chicago metropolitan area. Based in Carbondale and Springfield, the school built its educational and clinical foundations in cooperation with regional hospitals. Its mission is to improve the health of residents of central and southern Illinois through education, patient care, research, and community service. It selects Illinois residents, giving priority to applicants from rural and underserved areas in the central and southern regions. Applicants must be U.S. citizens or permanent residents living in Illinois who are prospective graduates of universities within the United States. They are required to have a minimum MCAT score of 498 out of 528 and an undergraduate grade point average of at least 2.8 out of 4.0, including science courses. The holistic admissions process uses document screening and faculty interviews to assess academic ability, work and volunteer experience, reflection on medically vulnerable populations, communication and teamwork, and potential as a community leader. The admissions committee makes the final decision through evidence-based discussions of responsibility, maturity, integrity, compassion, alignment with the school’s mission, motivation for applying, and commitment to community service.

MEDPREP and P4 provide support for admission. MEDPREP is a two-year post-baccalaureate program that assists racially and socioeconomically disadvantaged applicants with MCAT preparation and admission to medical and dental schools. From 1972 to 2022, 1,245 (74%) of the 1,674 MEDPREP entrants advanced to medical or dental schools, and 326 of these entered SIU SOM. P4 is an after-school program for Springfield School District 186 students, launched in 2009 in collaboration with public schools and the local medical society. It serves 80 participants annually and spans the four years from high school entry to graduation. Faculty, staff, and medical students volunteer, with medical students serving as problem-based learning (PBL) tutors. The program provides instruction in critical thinking and test-taking skills, guidance on admission procedures, career experience and mentoring, research participation, and college admission preparation. The authors present regional priority selection alongside these programs, treating opportunities to explore medical careers and prepare for admission as part of putting social accountability into practice.

As of January 30, 2024, SIU SOM had awarded MD degrees to 3,233 graduates. In the 2023 alumni data covering graduates from 1975 to 2022, 770 (33%) were engaged in primary care. Of the 901 practicing in Illinois, 484 (54%) worked in the central and southern regions, the school’s service area. The case report draws on accumulated faculty observations and internal data. The school ranked 15th in the United States on the social mission scale, which reflects the proportions of graduates engaged in primary care, working in health professional shortage areas, and drawn from underrepresented groups in medicine. The Lincoln Scholars Program, launched in 2020, selected 8 students from the central and southern regions in addition to the existing quota of 72. Based in Carbondale, these students completed most of the curriculum in rural areas, learned alongside Physician Assistant Program students, and received mentoring from rural primary care physicians. The program produced its first graduates in 2024 under LCME accreditation.

Curriculum and Operational Systems Supporting Community Family Medicine Careers

This case report on Canada’s QLH MD FM program describes how the goal of training a clinical workforce to meet healthcare needs informs admissions, education, faculty support, and community relations (Piliotis et al., 2026). According to data cited in the study, approximately 6.5 million Canadians, or one in five, lacked a family physician for regular care. The proportion of medical students naming family medicine as their first choice for residency training decreased from 38.5% in 2016 to 30.3% in 2023. Nearly 40% of family physicians in Ontario were considering retirement within the next few years. Almost 30% of family physicians were providing services outside primary care, such as emergency medicine and psychiatry. Discussions about a program jointly developed by Queen’s University Health Sciences, Lakeridge Health, and family physicians in the Durham region began in the fall of 2021. The program opened in September 2023. Drawing on over 10 years of educational collaboration between the two institutions, its design addressed six areas: admissions, curriculum, faculty and staff engagement, community engagement, infrastructure and support, and learner experience. Durham has a population of approximately 730,000, with one-third of residents belonging to visible minorities and one in four being an immigrant.

The admissions process developed into five stages: confirmation of minimum requirements and documentation, random selection of eligible applicants, Multiple Mini Interviews (MMI), file review and panel interviews, and a final decision. The program reviewed a separate short-answer questionnaire, an autobiographical sketch, and two confidential assessment forms. Panel interview questions and evaluation criteria addressed characteristics suited to a career in family medicine. The curriculum combined continuous community clerkships with a spiral structure that revisits patient cases of gradually increasing complexity. The first year is organized around the life cycle. It includes half-day clerkships with local family physicians throughout the academic year, as well as clerkships with rural family physicians for one week in early winter and one month in the spring. The second year covers more complex systems-based cases, integrating basic science with patients’ cultural and socioeconomic contexts. Separate classes reinforce concepts at students’ request, and intensive anatomy practicals take place at the end of the first year. The core learning objectives of the existing medical degree program are covered from a family medicine perspective. Assessment consists of direct observation by tutors, written evaluations, examinations, and practical assessments. Plans include strengthening subsequent rotations in the Durham region and educational support for the transition to family medicine residency.

Over 50 community physicians applied for new faculty positions, and a small group of selected clinical faculty shared teaching, mentoring, and curriculum responsibilities. Flexible hiring and compensation arrangements were established to give faculty sufficient teaching time and sustain their relationships with students. Onboarding, faculty development, and career and promotion support were also provided. Healthcare, academic, corporate, government, and service organizations participated in the Durham Physician Engagement Team, while Durham and its eight municipalities provided financial and in-kind support. Housing, transit, and care support; community activities; the LHEARN Centre’s education and simulation facilities; and counseling and career support helped learners participate in education and settle in the region. The ongoing mixed-methods evaluation examines participants’ experiences, support needs, and whether graduates provide comprehensive primary care.

Reading notes

In the UK, expectations of entering training, students’ intentions to leave, and doctors’ relinquishment of their licenses concern different groups and indicators. Each warrants interpretation within its own scope. SIU SOM graduates’ practice distribution requires interpretation in relation to the population and scope covered by the relevant data. The QLH MD FM case report presents program stakeholders’ accounts of development and implementation. It describes operational arrangements and design intentions. From an HRD perspective, the relationship between educational experiences and organizational operations can be studied through faculty teaching time and career support.

References

• Phillips, R. L., George, B. C., Holmboe, E. S., Bazemore, A. W., Westfall, J. M., & Bitton, A. (2022). Measuring graduate medical education outcomes to honor the social contract. Academic Medicine, 97(5), 643–648. https://doi.org/10.1097/acm.0000000000004592
• Ferreira, T., & Collins, A. M. (2025). Too many, too soon? Challenges in medical school expansion in the United Kingdom. Human Resources for Health, 23(1), 72. https://doi.org/10.1186/s12960-025-01038-8
• Han, H., & Klamen, D. (2024). Social accountability at Southern Illinois University School of Medicine: A focus on admission policy. Korean Medical Education Review, 26(3), 184–190. https://doi.org/10.17496/kmer.24.026
• Park, J., Kim, S., Kim, M., Kim, W. M., Yoo, S.-M., & Park, K. H. (2025). Quantitative changes in the number of basic medicine faculty at medical schools in Korea: A cross-sectional study. Journal of Korean Medical Science, 40(36), e263. https://doi.org/10.3346/jkms.2025.40.e263
• Piliotis, E., Turnnidge, J., McGuire, C. S., Dalgarno, N., Sanfilippo, A. J., Balasubramaniam, A., Gibson, M., Green, M., Watson, S., Fitzpatrick, R., Wax, R. S., McHattie, H., Ismiil, N., Jokic, R., Aziz, N., Stone, A., Grill, A., van Wylick, R., Stockley, D., & Philpott, J. (2026). Rethinking how we educate our future physicians: the Queen’s-Lakeridge Health Medical Degree Family Medicine program: an innovative approach to medical education. Canadian Medical Education Journal, 17(3), 38–54. https://doi.org/10.36834/cmej.81759